Your Privacy

APPA'S PATIENT PRIVACY NOTICE.

Confidentiality:

Your patient records are strictly confidential. For this reason, no information concerning you as a patient is released without your written consent. Disclosure of information to anyone such as another doctor, an attorney and/or a family member must be requested by written authorization by the patient. In an emergency situation when you, the patient, are at imminent risk of death or serious medical consequence, APPA will release minimal, critically relevant information to assist in preventing dire medical consequences that may result if that relevant information is not released. In the case of a minor, their legal guardian must sign the authorization. The physician is legally bound to break doctor-patient confidentiality in cases of threat of harm to self or others and in reports of child or geriatric abuse.

Medical Reports/Correspondence: Disability forms, work excuses, calls to employers, return to work letters, etc. will be provided on a fee basis. The fee must be prepaid in order for us to complete the requested task. The fee will be based on time spent preparing the requested information.

We are glad you have chosen APPA to provide your care. We will make every effort to provide you with quality care and professional support, respect and consideration. If you have any concerns, please bring them to the attention of our office staff immediately.

APP Disclaimers:

1. No cell phone is truly private. Using a cell phone is at your own privacy risk.

2. Texting is not private. Using text messages is prohibited for privacy reasons.

3. Only a landline is mostly HIPPA compliant. You assume risks and responsibilities for using any electronic device to communicate with our office.

If you are not able to tell us your preference, for example if you are

unconscious, we may go ahead and share your information if we believe it is

in your best interest. We may also share your information when needed to

lessen a serious and imminent threat to health or safety.

In these cases we never share your information

unless you give us written permission:

• Marketing purposes

• Sale of your information

• Most sharing of psychotherapy notes

In the case of fundraising:

• We may contact you for fundraising efforts, but you can tell us not to

contact you again.

Notice of Privacy Practices

How do we typically use or share your health information? We typically use or share your health information in the following ways:

Treatment Planning

• We can use your health information and share it with other professionals who are treating you. We take a team treatment approach which means that we do private professional consultations omitting patient identification, and we only consult on the symptoms and diagnosable conditions for a better informed treatment planning and patient care.

Example: A doctor treating you

for an injury asks another doctor

about your overall health condition.

We can use and share your health information

to run our practice, improve your care,

and contact you when necessary.

Example: We use health information

about you to manage your treatment

and services.

Bill for your services

• We can use and share your health information

to bill and get payment from health plans or

other entities.

Example: We give information

about you to your health insurance

plan so it will pay for your services.

Notice of Privacy Practices

How else can we use or share your health information? We are allowed or required to share

your information in other ways – usually in ways that contribute to the public good, such as public health and

research. We have to meet many conditions in the law before we can share your information for these purposes.

For more information see:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

• We can share health information about you for certain situations such as:

• Preventing disease

• Helping with product recalls

• Reporting adverse reactions to medications

• Reporting suspected abuse, neglect, or domestic violence

• Preventing or reducing a serious threat to anyone’s health or safety

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

* Work with a medical examiner or funeral director
• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

• We can use or share health information about you:

• For workers’ compensation claims

• For law enforcement purposes or with a law enforcement ofﬁcial

• With health oversight agencies for activities authorized by law

• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

• We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Georgia Law: Records and information relating to the mental health of an individual are confidential and

privileged to the patient, and may only be disclosed in accordance with the statute.

Disclosure With Consent:

A patient, parent of a minor patient, or legal guardian of a patient may consent in writing to the disclosure

of information relating to a patient’s mental health. A patient’s attorney may access the patient’s mental

health records, provided that the patient’s guardian consents.

Disclosure Without Consent:

Mental health information may be disclosed without a patient’s consent under the following circumstances:

· If the chief medical officer of the facility determines that disclosure to another provider is necessary for treatment purposes

· If the patient is being transferred to another facility, the record may be transferred

· Information may be exchanged between employees of the treatment facility for treatment purposes

· To providers during a medical emergency

· To law enforcement in connection with an investigation; information disclosed in this instance must be limited to whether the patient had been treated at that facility and the patient’s current address

· To law enforcement in connection with a crime on the premises of the facility; in this instance, information disclosed may include information about the incident as well.

Disclosure Pursuant to Court Order:

Mental health information may be disclosed pursuant to a valid subpoena or court order, unless the information is privileged. The records of a deceased patient may be released pursuant to a subpoena of a coroner or medical examiner, except for privileged information.

(Disclaimer: All electronic communications are not guaranteed to be HIPPA compliant and/or secure and/or private. Individuals calling APPA or emailing the APPA front desk assume full awareness and responsibility for their confidentiality and privacy. APPA staff are not responsible for your confidentiality and privacy from where you are calling us. Please ensure that you call from a securely private place when calling APPA about your mental health concerns.)